Adequate health literacy is associated with better health outcomes in people with type 2 diabetes in Mexico

ABSTRACT This study evaluates the health literacy of people with type 2 diabetes and its association with health outcomes. We conducted a cross-sectional survey in two family medicine clinics of the Mexican Institute of Social Security that included 778 diabetic patients >19 years of age. The Spanish version of the European Health Literacy questionnaire served to measure health literacy. Multiple logistic regressions were performed to determine the association between the independent variable (health literacy) and dependent variables (good self-rated health, glycemic control, and diabetes-related hospitalizations) after controlling for conceptually relevant patient’s characteristics. Only 17.6% of patients had adequate health literacy; while, the remaining percentage showed inadequate (23%), or problematic (59.4%) health literacy. After adjusting for the patients’ characteristics, those with adequate health literacy had 4.66 (95%CI: 2.26–9.61) times the odds of good self-rated health compared to those with inadequate literacy. Patients with adequate health literacy had 0.65 (95%CI: 0.49–0.86) times the odds of hospitalization due to diabetes compared to those with inadequate literacy. Compared to inadequate health literacy, problematic literacy was associated with increased odds of glycemic control. In conclusion, healthcare providers should actively address the health literacy needs of patients to increase good self-rated health, glucose control and reduce hospitalizations.

[1]  H. Brand,et al.  Health literacy, self-perceived health and self-reported chronic morbidity among older people in Kosovo. , 2015, Health promotion international.

[2]  Eun-Hyun Lee,et al.  A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes. , 2016, Asian nursing research.

[3]  Jennifer E. Moore,et al.  Agency for Healthcare Research and Quality , 2020, Definitions.

[4]  Benjamin Littenberg,et al.  Literacy and health outcomes: a cross-sectional study in 1002 adults with diabetes , 2006, BMC Family Practice.

[5]  I. Kickbusch,et al.  Advancing health literacy: a global challenge for the 21st century , 2000 .

[6]  S. Wieser,et al.  The costs of limited health literacy: a systematic review , 2009, International Journal of Public Health.

[7]  Y. Chapman,et al.  Self-management activities in diabetes care: a systematic review. , 2013, Australian health review : a publication of the Australian Hospital Association.

[8]  Michael Law,et al.  Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico , 2012, BMC Medical Informatics and Decision Making.

[9]  S. Lee,et al.  Effects of health literacy on health status and health service utilization amongst the elderly. , 2008, Social science & medicine.

[10]  Stacey L. Sheridan,et al.  Low Health Literacy and Health Outcomes: An Updated Systematic Review , 2011, Annals of Internal Medicine.

[11]  T. Barrientos-Gutiérrez,et al.  Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012) , 2015, PloS one.

[12]  K. Braun,et al.  The Influence of Community and Individual Health Literacy on Self-Reported Health Status , 2014, Journal of General Internal Medicine.

[13]  C. Tanasugarn,et al.  HEALTH LITERACY, MEDICATION ADHERENCE, AND BLOOD PRESSURE LEVEL AMONG HYPERTENSIVE OLDER ADULTS TREATED AT PRIMARY HEALTH CARE CENTERS. , 2016, The Southeast Asian journal of tropical medicine and public health.

[14]  O. Baron-Epel,et al.  The Association of Health Literacy with Health Behavior, Socioeconomic Indicators, and Self-Assessed Health From a National Adult Survey in Israel , 2016, Journal of health communication.

[15]  M. Romero,et al.  Alfabetización en salud; concepto y dimensiones. Proyecto europeo de alfabetización en salud , 1970 .

[16]  Ian M. Bennett,et al.  The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults , 2009, The Annals of Family Medicine.

[17]  Rafael Meza,et al.  Burden of type 2 diabetes in Mexico: past, current and future prevalence and incidence rates. , 2015, Preventive medicine.

[18]  G. N. Brito,et al.  Health literacy skills in type 2 diabetes mellitus outpatients from an university-affiliated hospital in Rio de Janeiro, Brazil , 2014, Diabetology & Metabolic Syndrome.

[19]  R. B. Saldaña,et al.  Conocimientos sobre diabetes mellitus en pacientes diabéticos tipo 2 tanto urbanos como rurales del occidente de México , 2007 .

[20]  W. Jacob-Filho,et al.  Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study , 2014, BMJ Open.

[21]  González Ramírez,et al.  Conductas problema en adolescentes en la ciudad de Monterrey, México Problem behaviors in adolescents in the city of Monterrey, Mexico , 2014 .

[22]  W. Herman The global burden of diabetes: An overview , 2017 .

[23]  D. Morrow,et al.  Factors Associated With Exacerbation of Heart Failure Include Treatment Adherence and Health Literacy Skills , 2009, Clinical pharmacology and therapeutics.

[24]  M. Coffman,et al.  Diabetes symptoms, health literacy, and health care use in adult Latinos with diabetes risk factors. , 2012, Journal of cultural diversity.

[25]  S. H. Kim Health literacy and functional health status in Korean older adults. , 2009, Journal of clinical nursing.

[26]  H. Hashimoto,et al.  Health literacy, socioeconomic status and self-rated health in Japan. , 2015, Health promotion international.

[27]  L. Dumenci,et al.  Health Literacy Is an Independent Predictor of Cancer Patients' Hospitalizations , 2017, Health literacy research and practice.

[28]  Rocco Palumbo Examining the impacts of health literacy on healthcare costs. An evidence synthesis , 2017, Health services management research.

[29]  D. Schillinger,et al.  Association of health literacy with diabetes outcomes. , 2002, JAMA.

[30]  Ace Ada Task Force on Inpatient Diabetes American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control , 2006, Diabetes Care.

[31]  K. Bibbins-Domingo,et al.  Low Literacy Is Associated with Increased Risk of Hospitalization and Death Among Individuals with Heart Failure , 2013, Journal of General Internal Medicine.

[32]  Jiang He,et al.  Mortality prediction with a single general self-rated health question , 2006, Journal of General Internal Medicine.

[33]  Gerardine Doyle,et al.  Health literacy and public health: A systematic review and integration of definitions and models , 2012, BMC Public Health.

[34]  Junling Ren,et al.  Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. , 2002, American journal of public health.

[35]  Cynthia Baur,et al.  Ten Attributes of Health Literate Health Care Organizations , 2012 .

[36]  Ellen Uiters,et al.  Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU) , 2015, European journal of public health.

[37]  Carlos Aguilar-Salinas,et al.  Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy , 2013, Globalization and Health.

[38]  Carmen R. Wilson VanVoorhis,et al.  Understanding Power and Rules of Thumb for Determining Sample Sizes , 2007 .

[39]  Rita A. Gómez-Díaz,et al.  Causas de descontrol metabólico en atención primaria , 2016 .

[40]  G. Doyle,et al.  Health Literacy: Concept and Dimensions. European Project of Health Literacy , 2012 .